Nurse's Notes

In timely fashion for Halloween, little creepy crawly creatures are continuing to make their presence known in Dakar communities. Who are these little creatures, you ask? They are none other than the notorious little creatures known as head lice (poux in French). Head lice can be transmitted from one child or person to another anywhere children and people get together and have an opportunity for close physical contact. This can occur at school, but also outside of school at extracurricular activities, sleepovers, playdates, dinner parties, birthday parties, and the like.

Here are some tips on how to prevent the spread of head lice, as well as more information on these little creepy crawlies. While lice are present year round they are more prevalent in hot humid weather, so take extra care to follow these tips now to keep your household lice-free!

Check all members of your household for lice or eggs (nits) regularly, about once or twice a week, during the hot humid season - make it a family routine!

Check your child's head before and after sleepovers and playdates.

Treat right away with special lice shampoo or lotion from your local pharmacy if lice or eggs are found. Check the package for a special lice comb too, and ask for one separately if it's not included. Follow directions exactly, for example some treatments are one time only, and others require a re-treatment about a week later.

Alert your child's school right away if lice or eggs are found, and ensure that your child has been treated before returning to school.

Use the comb! Even after treatment with a shampoo or lotion, eggs can and probably will, remain in the hair. Combing them out everyday is the best way to ensure that they will not hatch into more live lice.

Everyone should continue to monitor during the hot humid season. Whether or not lice are found, maintenance is the best way to prevent or spread an infestation of head lice.

Read below for lots more information:

The head louse is a tiny, wingless parasitic insect that lives among human hairs and feeds on tiny amounts of blood drawn from the scalp. Lice (the plural of louse) are a very common problem, especially for kids. They're contagious, annoying, and sometimes tough to get rid of. But while they're frustrating to deal with, lice aren't dangerous. They don't spread disease, although their bites can make a child's scalp itchy and irritated, and scratching can lead to infection. It's best to treat head lice quickly once they're found because they can spread easily from person to person.

Signs of Head Lice. Although they're very small, lice can be seen by the naked eye. Here are things to look for:

Lice eggs (called nits). These look like tiny yellow, tan, or brown dots before they hatch. Lice lay nits on hair shafts close to the scalp, where the temperature is perfect for keeping warm until they hatch. Nits look sort of like dandruff, only they can't be removed by brushing or shaking them off. Unless the infestation is heavy, it's more common to see nits in a child's hair than it is to see live lice crawling on the scalp. Lice eggs hatch within 1 to 2 weeks after they're laid. After hatching, the remaining shell looks white or clear and stays firmly attached to the hair shaft. This is when it's easiest to spot them, as the hair is growing longer and the egg shell is moving away from the scalp.

Adult lice and nymphs (baby lice). The adult louse is no bigger than a sesame seed and is grayish-white or tan. Nymphs are smaller and become adult lice about 1 to 2 weeks after they hatch. If head lice is not treated, this process repeats itself about every 3 weeks. Most lice feed on blood several times a day, and they can survive up to 2 days off the scalp.

Scratching. With lice bites come itching and scratching. This is actually due to a reaction to the saliva of lice. However, the itching may not always start right away — that depends on how sensitive a child's skin is to the lice. It can sometimes take weeks for kids with lice to start scratching. They may complain, though, of things moving around on or tickling their heads.

Small red bumps or sores from scratching. For some kids, the irritation is mild; for others, a more bothersome rash may develop. Excessive scratching can lead to a bacterial infection (this can cause swollen lymph glands and red, tender skin that might have crusting and oozing). If your doctor thinks this is the case, he or she may treat the infection with an oral antibiotic.

You may be able to see the lice or nits by parting your child's hair into small sections and checking for lice and nits with a fine-tooth comb on the scalp, behind the ears, and around the nape of the neck (it's rare for them to be found on eyelashes or eyebrows). A magnifying glass and bright light may help. But it can be tough to find a nymph or adult louse — often, there aren't many of them and they move fast. See your doctor if your child is constantly scratching his or her head or complains of an itchy scalp that won't go away. The doctor should be able to tell you if your child is infested with lice and needs to be treated. Not all kids have the classic symptoms of head lice and some can be symptom-free. Also be sure to check with your child's school nurse or childcare center director to see if other kids have recently been treated for lice. If you discover that your child does, indeed, have lice or nits, contact the staff at the school and childcare center to let them know.

Are Lice Contagious? Lice are highly contagious and can spread quickly from person to person, especially in group settings (like schools, childcare centers, slumber parties, sports activities, and camps). Though they can't fly or jump, these tiny parasites have specially adapted claws that let them crawl and cling firmly to hair. They spread mainly through head-to-head contact, but sharing clothing, bed linens, combs, brushes, and hats also can pass them along. Kids are most prone to catching lice because they tend to have close physical contact with each other and share personal items. And you may wonder if you pet cat or dog may be catching the pests and passing them on to your family. But rest assured that pets can't catch head lice and pass them on to people or the other way around.

Treatment. Your pharmacist or doctor can recommend a medicated shampoo, cream rinse, or lotion to kill the lice. These may be over-the-counter (OTC) or prescription medications, depending on what treatments have already been tried. Medicated lice treatments usually kill the lice, but it may take a few days for the itching to stop and directions must be followed exactly. For very resistant lice, an oral medication (medicine taken by mouth) might be prescribed. Make sure that the medicine is safe for your child's age. While over-the-counter shampoos are safe for kids as young as 2 months, other medicines are only safe for kids 2 years and older. It's important to follow the directions exactly because these products are insecticides. Applying too much medication — or using it too often — can increase the risk of harm. Follow the directions on the product label. Treatment may be unsuccessful if the medication is not used correctly or if the lice are resistant to it. After treatment, your doctor may suggest combing out the nits with a fine-tooth comb and also may recommend repeating treatment in 7 to 10 days to kill any newly hatched nits.

Removing By Hand. If your child is 2 months old or younger, you should not use medicated lice treatments. You'll need to remove the nits and lice by hand. To remove lice and nits by hand, use a fine-tooth comb on your child's wet, conditioned hair every 3 to 4 days for 3 weeks after the last live louse was seen. Wetting the hair beforehand is recommended because it temporarily immobilizes the lice and the conditioner makes it easier to get a comb through the hair. Wet combing is also an alternative to pesticide treatments in older kids. Though petroleum jelly, mayonnaise, or olive oil are sometimes used in an attempt to suffocate head lice, these treatments may not work. If medicine doesn't work and you want to try these methods, talk to your doctor first. Make sure you remove nits carefully every week for at least 3 weeks in a row, and watch your child closely to see if any live lice return.

Preventing Reinfestation. Because lice are easily passed from person to person in the same house, bedmates and infested family members also will need treatment to prevent the lice from coming back. Here are some simple ways to get rid of the lice and their eggs, and help prevent a lice reinfestation:Wash all bed linens and clothing that's been recently worn by anyone in your home who's infested in very hot water (130°F [54.4°C]), then put them in the hot cycle of the dryer for at least 20 minutes.

Dry clean anything that can't be washed (like stuffed animals). Or put them in airtight bags for at least 3 days.

Vacuum carpets and any upholstered furniture (in your home or car), then throw away the vacuum cleaner bag.

Soak hair-care items like combs, barrettes, hair ties or bands, headbands, and brushes in rubbing alcohol or medicated shampoo for 1 hour. You also can wash them in hot water or just throw them away.

Tips to Remember. These tips can help to prevent kids from getting lice (or from becoming reinfested):

Tell kids to try to avoid head-to-head contact at school (in gym, on the playground, or during sports) and while playing at home with other children.

Tell kids not to share combs, brushes, hats, scarves, bandanas, ribbons, barrettes, hair ties or bands, towels, helmets, or other personal care items with anyone else, whether they may have lice or not.

Tell kids not to lie on bedding, pillows, and carpets that have recently been used by someone with lice.

Every 3 or 4 days, examine members of your household who have had close contact with a person who has lice. Then, treat any who are found to have lice or nits close to the scalp.

Will They Ever Be Gone? As many parents know firsthand, lice infestation can be an ongoing battle, especially in group settings. There's no doubt that they can be hard bugs to get rid of. If you've followed every recommendation and your child still has lice, it could be because:

some nits were left behind

your child is still being exposed to someone with lice

the treatment you're using isn't effective

Be patient and follow the treatments and prevention tips as directed by your pharmacist or doctor, and you'll be well on your way to keeping your family lice-free!

The hot and humid weather of August and September make for great beach days along Senegal's Petite Cote. One can head to Toubab-Dialao, Saly-Portudal, or enjoy the beaches right here in Dakar, such as Plage du Virage - Ngor or the endless Plage du Yoff.

However, we must keep in mind that we live in sub - Saharan Africa, a region of the world that is home to many interesting little creatures. And as we know, knowledge is power. So the more you know about these little creatures the less opportunity they will have to hassle you and your family.

What creatures might be making an appearance right now?

The mango fly is endemic to the sub - tropics of Africa, and in it's larval stage, as a worm, it has a habit of burrowing under the skin of large mammals. The mango fly will drop it's eggs into moist soil or sand, or moist clothing or bed linens (like those on a clothing line). The eggs hatch into the "mango worm", and the worm may burrow into the skin of humans or dogs. What to look for: small boil - like sores or ulcers on the skin that may itch or become painful. In the beginning it may be mistaken for a mosquito bite. How to treat it: the mango worm rarely causes severe complications. To remove it apply petroleum jelly, Vicks vaporub, or Valda pommade to the sore to bring the worm to the surface and remove the whole worm with tweezers, pinching the skin may help. Wash the area thoroughly with soap and water and apply antibiotic ointment. How to prevent it: iron all clothing and linens that are hung outside to dry (kills the eggs), and avoid skin contact with moist or potentially contaminated soil or sand (for example right after a rainfall or sand on the beach where there may be a lot of dogs running around).

The hookworm is common in sub - tropical regions of Africa. Hookworm eggs hatch into larvae, and again can turn up in moist sand and soil. The hookworm larvae, like the mango worm, like to burrow into the skin. Generally speaking, the hookworms that we may come across in Dakar are feline and canine hookworms, which rarely develop into adulthood in humans. What to look for: red eruptions on the skin, often in lines, that are extremely itchy. The eruptions often occur on feet and hands. How to treat it: taking a pill, such as albendazole or mebendazole, for 1 to 3 days, should clear the infection. Also taking an antihistamine such as Benadryl can help relieve the itching. Wash the area thoroughly with soap and water and apply antibiotic ointment. How to prevent it: wear shoes and avoid skin contact with moist or potentially contaminated soil or sand (for example right after a rainfall or sandy areas and fields with dirt and soil, where there may be cats and dogs running around).

At ISD, we are aware that precautions are necessary when kids are out on our fields and playgrounds. Students must wear shoes when outside the classrooms. The sand playgrounds are closed after it rains, and are only opened up again after the sand has sufficiently dried.

These safety measures can be enforced during school hours, and because knowledge is power, we encourage our families to take the same precautions when enjoying our facilities during the weekend, or when out and about at the beach.

What is CPR?Cardiopulmonary resuscitation (CPR) is a lifesaving technique useful in many emergencies, including heart attack or near drowning, in which someone's breathing or heartbeat has stopped. The American Heart Association recommends that everyone — untrained bystanders and medical personnel alike — begin CPR with chest compressions. It's far better to do something than to do nothing at all if you're fearful that your knowledge or abilities aren't 100 percent complete. Remember, the difference between your doing something and doing nothing could be someone's life.

Here's advice from the American Heart Association:

Untrained. If you're not trained in CPR, then provide hands-only CPR (*to teens and adults). That means uninterrupted chest compressions of 100 to 120 a minute until paramedics arrive. You don't need to try rescue breathing.

Trained and ready to go. If you're well-trained and confident in your ability, begin with chest compressions instead of first checking the airway and doing rescue breathing. Start CPR with 30 chest compressions before checking the airway and giving rescue breaths.

Trained but rusty. If you've previously received CPR training but you're not confident in your abilities, then just do chest compressions at a rate of 100 to 120 a minute.

The above advice applies to adults, children and infants needing CPR, but not newborns.

What is an AED? An automated external defibrillator (AED) is a portable device that checks the heart rhythm and can send an electric shock to the heart to try to restore a normal rhythm. AEDs are used to treat sudden cardiac arrest (SCA).

At ISD, several of our staff members are trained in CPR and the use of our AED. Right on!

Vaccine Update: Pharmacie Guigon in Plateau and Pharmacie Arc En Ciel in Les Almadies are now confirmed to have the full coverage quadrivalent meningococcal vaccine Menactra to protect against meningitis. Institut Pasteur does not have the meningitis vaccine to date. And remember, summer break is a great time to review and make sure you and your family's routine and travel vaccinations are up to date!

Vaccine update 5/19/17: Dakar awaits the full coverage quadrivalent meningococcal vaccine to protect against meningitis (look for the name Menomune or Menactra). Some locations in Dakar (Pharmacie Guigon, Pharmacie Republique, Pharmacie Arc En Ciel) have a partial coverage vaccine (look for the name Meningo A / C). For those that are seeking the meningococcal vaccine, I suggest you discuss with your healthcare provider what is best for you and your family: to take what is available now, to wait for the full coverage vaccine to arrive in Dakar, or to wait until you travel, if you travel elsewhere, in the summer. Institut Pasteur does not have the vaccine at this time.

Today is International Nurses Day, an international day celebrated around the world on 12 May (the anniversary of Florence Nightingale's birth) of each year, to mark the contributions nurses make to society. I thought it would be interesting to take a look at how a school nurse contributes to a school. Follow this link to find out:

Now for a vaccine update: Dakar awaits the full coverage quadrivalent meningococcal vaccine to protect against meningitis (look for the name Menomune or Menactra). Some locations in Dakar (Pharmacie Guigon and Pharmacie Arc En Ciel) now have a partial coverage vaccine (look for the name Meningo). For those that are seeking the meningococcal vaccine, I suggest you discuss with your healthcare provider what is best for you and your family: to take what is available now, to wait for the full coverage vaccine to arrive in Dakar, or to wait until you travel, if you travel elsewhere, in the summer. Institut Pasteur does not have the vaccine at this time.

Parents, I ask that you review this message from last week. My latest communication with Institut Pasteur is that they are expecting to have the meningococcal vaccine in the beginning of May:

Please receive this important message and make sure you and your family's vaccinations, both routine and country-specific, are up-to-date. Remember, it is always better to prevent a disease than to treat it after it occurs.

Many illnesses that are common, or endemic, in Senegal can be prevented by vaccinations. One such illness is meningococcal meningitis. Senegal is one of almost 20 countries in the "meningitis belt" of sub-Saharan Africa. The prevalent season for meningitis in Senegal is during the dry season, in the months of December through June. We have confirmed with the US Embassy Health Unit in Dakar that there is currently an increase of cases of meningitis in some countries within the meningitis belt region. Senegal is not seeing an increase in meningitis cases at this time, but because Senegal is within this region, it is very important to be sure you and your family's meningitis vaccinations are up-to-date. Here is what you need to know:

Make sure you are vaccinated

Vaccines are available at Institut Pasteur de Dakar

Senegal is not currently seeing an increase in meningococcal meningitis cases

All sub-Saharan countries are at increased risk for meningitis

Below I have included links to the vaccine schedule for Institut Pasteur, more information about meningitis, and vaccination recommendations for Senegal. The meningitis vaccine is administered at the Institut Pasteur Monday through Saturday, just check the schedule for times. Please do not hesitate to contact me if you have questions.

*****UPDATE 4/21/17 at 1730: If you are seeking the vaccine please call the facility before you go to ensure availability. I was just informed by Institut Pasteur that the vaccine is unavailable right now as they await a delivery from Europe. If you are seeking the vaccine I would advise to call Institut Pasteur or your particular pharmacy ahead of time and inquire about availability.*****

A routine vision and hearing screening will be done at school beginning the week of March 27th, 2017. ISD will screen grades KG, 1, 3, 5, 7. If you’re child is not in these grades and you wish to have a screening done, please contact me.

If you do not want your child to be screened for any reason, please let the school know by notifying your child’s teacher or myself.

After the tests, you will receive a note from me only if it is recommended that your child receive further evaluation by a specialist.

In honor of the annual ISD vision and hearing screenings for select grade levels, here are some interesting facts about our EYES. Did you know?

Myth: Sitting too close to the TV is bad for the eyes. Fact: Although parents have been saying this ever since TVs first found their way into our homes, there's no evidence that plunking down right in front of the TV set damages someone's eyes (sorry!!). The American Academy of Ophthalmology (AAO) says that kids can actually focus up close without eyestrain better than adults, so they often develop the habit of sitting right in front of the television or holding reading material close to their eyes. However, sitting close to a TV may be a sign of nearsightedness.

Myth: If you cross your eyes, they'll stay that way. Fact: Contrary to the old saying, eyes will not stay that way if you cross them. If your child is crossing one eye constantly, schedule an evaluation by an ophthalmologist.

Myth: If parents have poor eyesight, their kids will inherit that trait. Fact: Unfortunately, this one is sometimes true. If you need glasses for good vision or have developed an eye condition (such as cataracts), your kids might inherit that same trait. Discuss your family's visual history with your doctor.

Myth: Eating carrots can improve vision. Fact: Although it's true that carrots are rich in vitamin A, which is essential for sight, so are many other foods (asparagus, apricots, nectarines, and milk, for example). A well-balanced diet can provide the vitamin A needed for good vision, says the AAO.

Myth: Computer use can damage the eyes. Fact: According to the AAO, computer use won't harm the eyes. However, when using a computer for long periods of time, the eyes blink less than normal (like they do when reading or performing other close work). This makes the eyes dry, which may lead to a feeling of eyestrain or fatigue. So encourage your kids to take frequent breaks from Internet surfing or video games.

Myth: Two blue-eyed parents can't produce a child with brown eyes. Fact: Two blue-eyed parents can have a child with brown eyes, although it's very rare. Likewise, two brown-eyed parents can have a child with blue eyes, although this is also uncommon.

Myth: Only boys can be color-blind. Fact: It's estimated that up to 8% of boys have some degree of color blindness, whereas less than 1% of girls do.

Myth: The eye is full size at birth. Fact: The eye is NOT full size at birth but continues to grow with your child. This growth partially accounts for refractive (glasses) changes that occur during childhood.

Myth: Wearing glasses too much will make the eyes "dependent" on them. Fact: Refractive errors (near-sightedness, far-sightedness, or astigmatism) change as kids get older. Many variables come into play, but most of this change is likely due to genetics and continues despite wearing glasses earlier or later or more or less. Wearing glasses does not make the eyes get worse.

In honor of St. Valentine's Day, here are some HEART-healthy recipes for kids and adults!

What makes a recipe heart healthy? Look for ingredients that are good for your heart: like the olive oil, nuts, and even chocolate in these recipes. Heart-healthy foods also are low in saturated fat and salt. So get cooking and then get eating! Click on the links below to open the recipes, and enjoy.

Oatmeal doesn't have to be served in a bowl. Make your own whole-grain Blueberry Oatmeal Squares, studded with good-for-you blueberries. You can substitute with other berries or raisins if you don't have blueberries!